WHO warns sexually transmitted gonorrhea becoming drug resistant

Geneva
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Gonorrhea, a sexually transmitted disease (STD), is growing resistant to antibiotic drugs and could become untreatable warns the World Health Organization (WHO). Resistance has even been reported in countries with adequate healthcare systems.

WHO's warning followed a February alert and May Webinar from the Centers for Disease Control (CDC), who also warned that cephalosporin-resistant gonorrhea or antibiotic-resistant gonorrhea, would significantly complicate the ability to treat gonorrhea successfully.

According to trends investigated by the CDC, "in 1993, ciprofloxacin (a fluoroquinolone) and cephalosporins (ceftriaxone and cefixime) were the recommended treatments for gonorrhea," but by the late 1990s and early 2000s the Center said, "ciprofloxacin resistance was detected in Hawaii and the West Coast."

Four years later by 2004, ciprofloxacin resistance was also detected among men who have sex with men (MSM) with gonorrhea, and by 2006, resistance to ciprofloxacin, and ciprofloxacin resistance was present in all regions of the country, including the heterosexual population. It forced the CDC in 2007 to stop recommending fluoroquinolones as treatment for gonococcal infections for all persons in the US.

Caused by the bacterium Neisseria gonorrhoeae, of the 498 million new cases of treatable STDs said WHO, one quarter or "an estimated 106 million people," are infected with gonorrhea each year. Alarmingly, cases of resistance to cephalosporin antibiotics have been reported in several countries considered to have well-developed health systems such as Australia, France, Japan, Norway, Sweden and the United Kingdom.

Dr Manjula Lusti-Narasimhan, from the Department of Reproductive Health and Research at WHO, said in a press release that "gonorrhoea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options." Once treated readily with penicillin, the doctor warned that current available data is only the tip of the iceberg, and without adequate surveillance:

We won’t know the extent of resistance to gonorrhea [...] without research into new antimicrobial agents, [...meaning...] there could soon be no effective treatment for patients.

CDC: The lesion on this patient’s left hand was due to the systemic dissemination of the Neisseria gonorrhoeae bacteria. Though sexually transmitted, and involving the urogenital tract initially, a Neisseria gonorrhoeae bacterial infection can become disseminated systemically, manifesting itself as a cutaneous erythematous lesion anywhere on the body.

CDC/PHIL

Perhaps worse, gonorrhea is the second most common sexually transmitted infection after chlamydia, and the CDC estimates that, annually, more than 700,000 people in the United States get new gonorrhea infections but less than half of these infections are reported to the CDC. In 2010 for example, the Center said they received reports of only 309,341 cases of gonorrhea.

Gonorrhea grows easily in warm, moist areas such as the reproductive tract, the cervix, the uterus and fallopian tubes in women. It also affects the urine canal in both women and men and can flourish in the mouth, throat, eyes, and anus. When it is left untreated WHO said:

Gonococcal infection can cause health problems in men, women and newborn babies including infertility in both men and women; a significantly increased risk of HIV infection and transmission; ectopic pregnancy, spontaneous abortion, stillbirths and premature deliveries; and severe eye infections occur in 30-50% of babies born to women with untreated gonorrhoea, which can lead to blindness.

As a result, WHO is calling for urgent action to be taken saying that greater vigilance on the correct use of antibiotics and more research into alternative treatment regimens for gonococcal infections is needed. The organization has launched the WHO Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhea. The plan asks for "increased monitoring and reporting of resistant strains as well as better prevention, diagnosis and control of gonococcal infections."

Dr Lusti-Narasimhan said WHO is very concerned about recent reports of treatment failure from the last effective treatment option – the class of cephalosporin antibiotics, and with "no new therapeutic drugs in development" she explains, the bug could become a super bug with the potential to cause "significant health implications."

One problem is that gonorrhea doesn't always present with symptoms; when symptoms are present, they are common enough to other infections and can be misdiagnosed. "Men may have a burning sensation when urinating, or a white, yellow, or green discharge from the penis that usually appears 1 to 14 days after infection," says the CDC. Ocassionally men with gonorrhea will also get painful or swollen testicles.

In women, initial symptoms may include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. But for women, treatment is encouraged as soon as possible; gonorrhea in women explains the CDC, leaves them "at risk of developing serious complications from the infection, even if symptoms are not present or are mild."

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements, or may cause no symptoms at all. Infections in the throat may present as a simple sore throat.

WHO said the best protections measures are always preventative ones. "Gonorrhoea can be prevented through safer sexual intercourse" the organization explained, adding that "early detection and prompt treatment, including of sexual partners, is essential to control sexually transmitted infections."